Essential Guide to Reducing Surgery Complications - Surgery abroad with Globe Health Tours.

A Guide to Reducing Surgical Complications

Having surgery is a risky business. Many of the risks and other important topics relating directly to having an operation are covered in some detail in our guides entitled;

It is vital that all prospective patients read and understand the information contained in these two pages. This guide is intended for all patients who wish to know more about how to reduce their chances of a surgical complication. Most of what is contained here is basic common sense. Nevertheless, we hope that by reading about these factors which we have tried to set out in a logical way, we will encourage patients to consider these simple but potentially life saving issues seriously. By doing this, we further hope that patients themselves will be more motivated to act on these ideas, thus taking a more proactive approach to managing the risk associated with surgery.

As in the guides mentioned above, potential complications are listed below and methods by which these can be minimised are suggested. It cannot be stressed strongly enough that the risk of any operation, surgical procedure or invasive investigation can never be reduced to zero. Even in the most ideal circumstances, some element of risk will always remain.

Anaesthetic Risk

There is an inherent risk to all patients having anaesthesia of any sort. Not surprisingly, general anaesthesia carries the greatest risk whereas local anaesthesia is less risky. Although patients (by definition) may be unwell and therefore require an operation, the more fit generally a patient is, the better his/her chances are of having a successful outcome. Consideration of lifestyle factors, as well as other issues, is therefore vital.

1. Smoking

Smoking has a well recognised negative effect on the heart, lungs and circulation. This effect will therefore definitely increase patient’s risk greatly of developing an anaesthetic related complication. It is strongly recommended that all patients quit smoking well before their surgery. This will substantially reduce their risks.

2. Obesity

Being overweight greatly increases the chances of patients developing anaesthetic related complications. It is strongly advised that all patients try to loose as much of their excess weight as possible.

3. General Level of Fitness

This is an important risk factor. It is important for patients to be as fit as possible. Patients are encouraged to participate in as much aerobic exercise as medically possible to increase their level of fitness well before the operation is due.

4. Routine Medication

It is vital for all patients to follow strictly all medical guidance and advice from their physicians or surgeons. This includes instructions on which medicines to take, their frequency, strength and method of administration. This advice should never be ignored or deviated from.

5. Declaration of Previous and Present Medical History

Doctors and surgeons can only fully help patients and reduce risks if they are in a position where full and concise medical details are available to them. Without this information, vital details about patients may be overlooked leading to potential problems. Patients are always therefore advised to produce or make available all medical details, results and reports of previous tests and investigations and any other pertinent information. Details such as allergies and adverse reactions are especially critical.

6. Control of Co-existing Medical Conditions

It is well understood by doctors that if patients suffer from other medical conditions (not related directly to the operation itself) they carry a greater surgical risk. This applies to almost any chronic medical illness such as;

heart disease e.g. angina,
lung disease e.g. emphysema, asthma or chronic bronchitis,
diabetes mellitus,
chronic liver disease,
chronic kidney disease,
high blood pressure,
many other medical conditions.

To minimise this risk as much as possible, it is imperative that patients (with the assistance of their doctors) take all appropriate measures to control these co-existing diseases as much as possible. For example, a well controlled diabetic patient will carry far less risk than one who is poorly controlled for the same surgical procedure.

Aspiration

It is vital to strictly follow all guidance and advice from surgeons and nurses immediately prior to the operation. Instructions to patients usually include being “nil by mouth” for several hours before an operation. This will greatly reduce patient’s chances of vomiting through an operation, thus reducing risks.

Blood Loss

This risk is difficult to minimise for individual patients. But if patients are aware of being anaemic before surgery, this should be declared. Every effort should be made to correct the anaemia and deal with the underlying causes of this anaemia if possible. This may include taking iron tablets for several weeks as well as other measures.

Blood Clots (Thrombosis)

A detailed list of risk factors for developing a blood clot are listed in our guide entitled “An Essential Guide to Having Surgery”. Many of these factors are impossible to change. For example, if patients are having certain types of procedures, they may be at increased risk of developing blood clots. However, there are other high risk factors which patients can modify and reduce. These include;

1. Flying

Patients are strongly encouraged to follow advice from airlines strictly as regards reducing the risk of developing a blood clot is concerned. Passengers are usually encouraged to keep as mobile as possible, exercise various muscle groups such as those of the ankles, calves and thighs, wear support stockings or flight socks and keep as well hydrated as possible by drinking fluids and avoiding alcohol while on board aircraft.

2. Immobilisation

Patients are usually encouraged to mobilise as soon as possible after surgery. This greatly reduces the chances of developing clots. Patients should therefore be compliant of all medical advice and participate with such activities as physiotherapy and other rehabilitation programmes.

3. Weight

Obese and overweight patients are usually encouraged to loose as much of their excess weight as possible.

4. Smoking

Smokers are always encouraged to quit and thus lower their chances of developing a blood clot.

5. Contraception

Women who take the combined oral contraceptive pill are usually advised to stop the pill approximately 1 month before all major operations. Clearly, other methods of contraception should be used in the interim.

6. Anti-coagulant Medication

Patients must comply with the advice given by doctors regarding the use of anti-coagulants. These are drugs given usually in injectable form to reduce the risk of blood clots forming. These medicines are usually started after surgery and are especially useful for patients travelling home by aeroplane.

Infection

Controlling and reducing the rates of infection after surgery is clearly of major importance to patients. Many factors causing infections are clearly outside the control of patients themselves. Such factors include;

type of procedure being done,
the site in the body being operated on,
the cleanliness of the operating theatre,
the arrangements for sterilising surgical equipment,
the cleanliness of the general hospital wards,
the skill of the surgeon,
the general state of the patient,
the general approach of the whole hospital team to infection control measures.

But several other factors are amenable to being reduced by patients. These include;

stopping smoking,
loosing weight,
tightly controlling co-existing medical conditions,
complying strictly with the taking of medication,
taking active steps to improve their own personal hygiene. Central to this is hand washing after toileting and after contact with other people who may inadvertently be a source of infection. Such people include friends, members of family, other patients and even staff.
using alcohol hand gel/rubs to further increase personal hygiene measures and also encouraging other in close proximity to do the same,
patients can often highlight issues with their hospital rooms (though this should be rare in most modern and well managed institutions). Issues such as inadequate cleaning, changing of bed sheets, availability of liquid soap, availability of disposable hand towels and other factors should be reported to hospital nursing or domestic staff,

patients must comply with all medial decisions and instructions in the rehabilitation process. Clearly, the treating clinical team is in the best position to know how best to improve the chances of a successful outcome after the operation and how to speed up the recovery process. The quicker the recovery process, the lower the risk of infection. However, balanced with this, patients are also minded not to push for earlier than recommended discharge from hospital as this too may compromise recovery.

Other Factors

Many patients travel abroad to seek surgical procedures and also to have a vacation or holiday at the same time. Whereas this may be ideal for many patients, it must be stressed by Globe Health Tours that surgery is always seen as the primary reason to arrange a trip with us. Any plans for travel for leisure and sight seeing take a very secondary role. Therefore, patients are strongly encouraged to always follow the advice of the treating clinical team before arranging an intensive holiday itinerary. Doing too much too quickly can be extremely harmful to patients. A more relaxing break in close proximity to the hospital during the rehabilitation period is usually more sensible.